Potential Financial Effects on Hospitals of the Removal of Common Orthopaedic and Spinal Procedures From Medicare's "Inpatient-Only" List: A Comparison of the Medicare Fee-for-service Payment Model Versus Maryland's Global Budget Revenue Model.

Charles F S Locke¹, Ronald L Hirsch, Edward P Hu, Andrew H Hughes, James R Ficke

¹From the Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD (Locke, Hughes), the R1 RCM Inc. Chicago, IL (Hirsch), the University of North Carolina Healthcare System, Chapel Hill, NC (Hu), the Department of Care Coordination/Clinical Resource Management, The Johns Hopkins Hospital, Baltimore, MD (Hughes), and the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD (Ficke).

PubMed DOI

Abstract

BACKGROUND: When treating Medicare beneficiaries, orthopaedic surgeons must follow Centers for Medicare & Medicaid Services (CMS) policies regarding whether to perform surgical treatments under inpatient or outpatient status. Recently, most orthopaedic and spinal procedures were removed from the CMS's "inpatient-only" list (IPOL). We investigated differences in hospital payments under the Diagnosi…

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